Does Running cause Arthritis?

Over many years, it has been believed that the repetitive action of running increases the risk of developing arthritis in the knee and hip. Without the accurate imaging that is available today, it would be obvious to hazard a guess at running being a risk factor. After all, our joints aren’t designed to withstand the forces involved with running long distances, right?

First of all, what is arthritis?

Osteoarthritis (OA) is a common condition and effects around 20 million people in the USA alone. It is often thought of as degeneration or wear and tear of the bone. Evidence now shows that OA is a process that involves many structures of the joint, including the synovial fluid (acts as a shock absorber), underlying bone, the joint capsule and other joint tissues.

With this degeneration, space between the joint can be lost, whether it is in the lower back, neck or knee. Often, in regards to the knee, the space on the medial side of the knee is often lost, which can cause the knee to adopt a position pointing inward. Symptoms are often reported as a deep ache in the joint, limited range of movement and often worse in a morning and eases once mobile.

The most common risk factors for OA are;

·         Age (80-90% of people over 65 have signs of arthritis, it isn’t always symptomatic)

·         Obesity

·         Trauma

·         Genetics

·         Repetitive use???

If repetitive use is a risk factor, shouldn’t that correlate with running? Surprisingly not. Various evidence, including imaging of the knee shows no significant difference when comparing elite runners (100km per week) to those who run 20km per week.

Theories suggest that knee OA is predisposed by a collective amount of force on the joint over a period of time, this is called cumulative load. When compared to walking, running has a higher peak load per stride (as a higher load goes through the joint with each stride), however the cumulative or average load per stride over the same distance as walking is quite the same.

Another suggestion is that cartilage in a healthy state, adapts to the load and is able to withstand the greater stress frequently sustained when running. The exact reasoning is not definite, more research is needed but there is enough evidence to indicate that, if someone does not have predisposing risk factors, there is no correlation between running and knee OA.  

Various problems can occur with the knee joint, its important to accurately identify the causation and effect to manage the pain and tackle the problem at hand. As an Osteopath, a hands-on assessment helps to do so.

Don’t be scared to run, it won’t ruin your knees.

Josh Kelsall (M.Ost)

Achilles Pain and Running

The Achilles is the thick tendon from the lower calf to the heel. As you might have seen quite recently, David Haye reportedly ruptured his Achilles tendon in the boxing match against Tony Bellew. The relevance of this example is the similarities between boxing and running. You repetitively push off from your foot, activating your calf muscle (gastrocnemius) and adding load to the Achilles tendon.

As you can imagine, the repetitive action of running activates the calf muscle with every stride, hence runners being prone to Achilles pain. Often diagnosed as Achilles tendonitis, 6-18% of runners are hindered by this common problem, affecting 1 million athletes every year. The onset is often a gradual build up, suggested to be down to intermittent, overuse and high force activities.

A complete rupture is less common. It usually occurs in males between the ages of 30-50 who are often described as ‘weekend warriors.’ In other words, they work all week and do no physical exercise and then go mad for sports on a weekend.

Are you experiencing pain in the Achilles?

·         Achilles and/or calf pain with possible swelling.

·         Pain when activating the calf (walking, jumping etc)

·         Possible thickening of the tendon.

·         Stiff and painful in the morning, can ease through the day.

What can you do?

Unfortunately, you have to cut down on the running. If you’re already suffering with Achilles pain, the repetitive loading of the lower limb will make it much worse. The Achilles needs time to repair, if you’re still applying high force to the area it doesn’t have a chance to do so. Try walking the length of a swimming pool instead. This will reduce the pressure on the Achilles but still enable a good workout.

Hot and cold therapy – tendons have a poor blood supply so can take longer to heal than muscle injuries. By repeatedly applying 5 minutes of ice followed by 5 minutes of heat for 30-minute cycles, the blood vessels will restrict and dilate. This acts as a pumping mechanism, encouraging blood flow to the area. Blood provides the essentials for repair…

Consult an Osteopath. This can effect anyone, you don't have to be an athlete to aggravate your Achilles. As as Osteopath, we assess your gait, biomechanical dysfunction, provide hands on therapy and tailor your rehabilitation programme in order to return to normal daily function and sports as soon as possible. Treatment will usually consist of targeting the posterior chain of the lower extremity, not just the calf.

Does stretching benefit running?

Should you stretch immediately before or after a run? No. Contrary to most beliefs, research suggests that an acute phase of stretching (before or after exercise) does not show any benefits and indicates a possible decrease in performance and increase risk of injury.

Surely that can’t be right??

Muscular stiffness has been considered to cause injury and inhibit performance. However, it appears to be desirable for long-distance runners as stiff muscles around the hip, knee and ankle joints can increase stability and force production during the gait cycle, reducing the required muscle activation to maintain stability. More force production with less energy output = better running economy, better results.

Following this, stretching before a run has been shown to recruit more motor units (coordinate muscle contractions) in a muscle to perform the same work. More motor units = more oxygen consumption + energy expenditure. “No studies were able to suggest that stretching immediately before an endurance running event could improve running economy.” (Shrier, I. 2004).

Don’t be completely put off of stretching. Regular stretching is shown to be beneficial in other sporting disciplines, can improve your flexibility and is often used as part of a rehabilitation programme. Furthermore, stretching regularly (not before or straight after training) is suggested to have no negative impact on your running economy.

Delayed Onset Muscle Soreness (DOMS)

Will stretching help your DOMS? I’m sure everyone has experienced the inability to get off the toilet seat or make their way downstairs for the following days after a hard session running or training legs. This is DOMS. Commonly experienced 24-48 hours after exercise and the leading cause of reduced performance. Depending on the state of the muscle, stretching can actually prolong soreness/injury.

I always see people stretching in between sets or straight after a heavy session. This will not benefit you what so ever and can decrease power and increase risk of injury. There is substantial evidence to show that stretching does not reduce DOMS or improve performance. Instead of stretching, try hot/cold therapy which is shown to aid recovery.

Josh Kelsall (M.Ost)